Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain.
CONCLUSION: Diagnostic testing and hospitalization rates for chest pain and abdominal pain between APPs and physicians is largely similar after matching for severity and complexity. This suggests that APPs do not have observably higher use of ED and hospital resources in these conditions in this national group. PMID: 33107088 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 27, 2020 Category: Emergency Medicine Authors: Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group Tags: Acad Emerg Med Source Type: research

Awake prone positioning in COVID-19 hypoxemic respiratory failure: exploratory findings in a single-center retrospective cohort study.
CONCLUSIONS: Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials. PMID: 33107664 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 27, 2020 Category: Emergency Medicine Authors: PadrĂ£o EM, Valente FS, Besen BA, Rahhal H, Mesquita PS, de Alencar JC, da Costa MG, Wanderley AP, Emerenciano DL, Bortoleto FM, Fortes JC, Marques B, de Souza SF, Marchini JF, Neto RA, de Souza HP, COVIDTEAM Tags: Acad Emerg Med Source Type: research

Hot off the Press: Antacid Monotherapy for Epigastric Pain.
This study compares antacid monotherapy with two combinations of lidocaine with antacid in the treatment of dyspepsia. PMID: 33098609 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 24, 2020 Category: Emergency Medicine Authors: Bond C, Morgenstern J, Heitz C, Milne WK Tags: Acad Emerg Med Source Type: research

Low-dose ketamine for acute pain control in the emergency department: A systematic review and meta-analysis.
CONCLUSION: LDK and morphine had similar analgesic effectiveness within 60 minutes of administration with comparable safety profiles, suggesting that LDK is an effective alternative analgesic for acute pain control in the ED. PMID: 33098707 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 24, 2020 Category: Emergency Medicine Authors: Balzer N, McLeod S, Walsh C, Grewal K Tags: Acad Emerg Med Source Type: research

Supply and Demand of Emergency Medicine Board-certified Emergency Physicians by U.S. State, 2017.
Abstract OBJECTIVES: Our objective was to estimate the emergency medicine board-certified emergency physician (EMBC EP) workforce supply and demand by U.S. state. METHODS: To estimate state demand, we applied the methodology from our 2005 analysis to calculate full-time equivalent (FTE) EMBC EP demand for each emergency department (ED). The 2017 National Emergency Department Inventory-USA provided visit volumes for all EDs, while the American Board of Medical Specialties supplied the 2017 number of EMBC EPs per state. Assuming at least one EMBC EP should be present 24/7 in each ED (requiring 5.35 FTEs minimum...
Source: Accident and Emergency Nursing - October 23, 2020 Category: Emergency Medicine Authors: Clay CE, Sullivan AF, Bennett CL, Boggs KM, Espinola JA, Camargo CA Tags: Acad Emerg Med Source Type: research

Vacation Interuptus.
Abstract It's been nothing like a normal summer, but I think a few of us have found a way to get some time off in between the chaos. I always managed to get away for a week or two to a small island off the New England coast for a vacation with my family and friends. I've been doing it for 30+ years and it instantly gives me the grounding I need. PMID: 33091226 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 22, 2020 Category: Emergency Medicine Authors: McCormack RF Tags: Acad Emerg Med Source Type: research

Inequities of the COVID-19 Pandemic Among Minority Populations: My Family's Struggle to Survive.
Abstract I was on my surgical rotation in March 2020 when I decided to visit my parents for my mother's birthday. During my visit, my medical school joined many across the tristate area to suspend all clinical rotations because of the burgeoning COVID-19 outbreak. I reverted to online classes and sheltered in place at my parents' home in the Bronx. As a first-time mother to a four-month-old baby girl, the outbreak terrified me. PMID: 33078465 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 20, 2020 Category: Emergency Medicine Authors: Wynter C Tags: Acad Emerg Med Source Type: research

Liberal vs Restrictive Hemoglobin Levels as Thresholds for Blood Transfusions.
Abstract Blood transfusion is a common treatment of anemia due to chronic disease or acute blood loss. However, there continues to be uncertainty concerning the appropriate threshold for transfusion. A restrictive protocol could decrease blood administered, transmissible infections, transfusion reactions, volume overload, and utilization of a limited commodity. However, anemia may result in decreased oxygen delivery which could lead to metabolic dysfunction an increased cell death. Determining an appropriate transfusion threshold is thus an important objective. A previous Cochrane review found the use of restricti...
Source: Accident and Emergency Nursing - October 17, 2020 Category: Emergency Medicine Authors: Hillenkamp JZ, Wolfson AB Tags: Acad Emerg Med Source Type: research

From Presentation to Paper: Assessment of Successful Abstract Publications in Emergency Medicine Over a Five-Year Period.
Abstract presentations are a mechanism to present and discuss up-to-date research with attendees. However, dissemination of research findings is limited when relying upon conference presentations in isolation. While some conference proceedings may be published or available online, they are not as easily found as peer-reviewed publications and many are not indexed in major search databases.1 Additionally, abstracts often provide limited details about study methodology, which can make it challenging to adequately assess the study limitations. This can impact the understanding of current research in our field and lea...
Source: Accident and Emergency Nursing - October 14, 2020 Category: Emergency Medicine Authors: Gottlieb M, Ryan K, Alcorn T, Clayton GC, Kuhns M, Slagle W, Wirfs L, Peksa GD Tags: Acad Emerg Med Source Type: research

Comparison of the Loop Technique with Incision and Drainage for Skin and Soft Tissue Abscesses: A Systematic Review and Meta-Analysis.
CONCLUSION: The LDT was associated with reduced treatment failures when compared with CID. Future studies should further assess the impact on pain, cosmetic outcomes, and healthcare costs. PMID: 33037713 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 9, 2020 Category: Emergency Medicine Authors: Gottlieb M, Schmitz G, Peksa GD Tags: Acad Emerg Med Source Type: research

Response to AEMJ-20-1087.R1.
Abstract The authors appreciate the comments of Dr. Corbin and his colleagues, as well as those of our colleagues suggesting our findings are "premature conclusions." A primary concern of our colleagues pertains to the limited number of confounders adjusted in our analyses. Indeed, while we were able to adjust for two of the variables noted (substance use and mental health diagnoses), we did not have the data available in this study to analyze potential effects of infection, neurovascular or metabolic complications, or trauma. PMID: 33034110 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 8, 2020 Category: Emergency Medicine Authors: Macias-Konstantopoulos W, Schnitzer K, Merideth F, Hayden D, Shtasel D, Bird S Tags: Acad Emerg Med Source Type: research

Airway Breathing Circulation: An Emergency Medicine Resident's Experience of the Beirut Explosion.
Abstract When 2700 tons of Ammonium Nitrate explode, destroying half a city, no one comes out unscathed. We reflect here on the experience of an Emergency Medicine (EM) Resident the night of the Beirut port explosion. PMID: 33022837 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 5, 2020 Category: Emergency Medicine Authors: Abdul Nabi SS, Sawaya RD Tags: Acad Emerg Med Source Type: research

Does IV Acetaminophen Reduce Opioid Requirement in Pediatric Emergency Department Patients with Acute Sickle Cell Crises?
CONCLUSION: In this study, patients who received IV acetaminophen did not receive less morphine than patients in the placebo group. Disposition pain scores for the 2 groups were also equivalent. We conclude that IV acetaminophen, when used in addition to morphine for pediatric sickle cell VOC pain, does not provide an opioid sparing effect. Further searches for adjunctive non-addictive pain medicines are indicated. PMID: 33025690 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 5, 2020 Category: Emergency Medicine Authors: Dhebaria T, Sivitz A, Tejani C Tags: Acad Emerg Med Source Type: research

Increased Incidence of Acute Pulmonary Embolism in Emergency Department Patients During the COVID-19 Pandemic.
Abstract Early detection of acute pulmonary embolism (PE) in patients with SARS-CoV-2 infection is integral to the clinical management of these patients. Many recently published studies have evaluated incidence of PE in hospitalized patients with COVID-191-9 , however there is relatively limited data describing patients with SARS-CoV-2 infection and concomitant diagnosis of acute PE upon initial presentation. Therefore, the purpose of this study is to (i) evaluate the incidence of acute pulmonary embolism (PE) in patients undergoing computed tomography pulmonary angiography (CTPA) in the emergency department (ED) ...
Source: Accident and Emergency Nursing - October 4, 2020 Category: Emergency Medicine Authors: Watchmaker JM, Goldman DT, Lee JY, Choi S, Mills AC, Toussie D, Finkelstein M, Sher AR, Jacobi AH, Bernheim AM, Chung MS, Eber CD, Lookstein RA Tags: Acad Emerg Med Source Type: research

Outcomes in Hispanics with Covid-19 are similar to Caucasian patients in Suburban New York.
CONCLUSIONS: Hispanics presented at higher rates than average for our population but outcomes among Hispanic patients with Covid-19 were similar to Caucasian patients. PMID: 33015939 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - October 4, 2020 Category: Emergency Medicine Authors: Valenzuela RG, Michelen Y, Bracey A, Cruz P, Fombonne B, Fries BC, Mallon WK, Fernandes R, Thode HC, Singer AJ Tags: Acad Emerg Med Source Type: research

The Effect of Trauma Center Verification Level on Outcomes in TBI patients undergoing Inter-facility Transfer.
Abstract BACKGROUND: Previous literature demonstrates increased mortality for Traumatic Brain Injury (TBI) with transfer to a Level II versus Level I trauma center. Our objective is to determine the effect of the most recent American College of Surgeons-Committee on Trauma (ACS-COT) Resources for the Optimal Care of the Injured Patient resources manual ("The Orange Book") on outcomes after severe TBI after interfacility transfer to Level I vs Level II center. METHODS: Utilizing the Trauma Quality Program Participant Use File (TQP-PUF) of the American College of Surgeons (ACS) admission year 2017, we...
Source: Accident and Emergency Nursing - October 2, 2020 Category: Emergency Medicine Authors: Plurad DS, Geesman G, Mahmoud A, Sheets N, Chawla-Kondal B, Ayutyanont N, Ghostine S, Guldner G Tags: Acad Emerg Med Source Type: research

Racial and Ethnic Disparities in the Delayed Diagnosis of Appendicitis Among Children.
CONCLUSIONS: In this multicenter cohort, there were racial disparities in appendiceal perforation. There were also racial disparities in rates of delayed diagnosis of appendicitis and diagnostic imaging during prior ED visits. These disparities in diagnostic imaging may lead to delays in appendicitis diagnosis, and thus, may contribute to higher perforation rates demonstrated among minority children. PMID: 32991770 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 28, 2020 Category: Emergency Medicine Authors: Goyal MK, Chamberlain JM, Webb M, Grundmeier RW, Johnson TJ, Lorch SA, Zorc JJ, Alessandrini E, Bajaj L, Cook L, Alpern ER, Pediatric Emergency Care Applied Research Network (PECARN) Tags: Acad Emerg Med Source Type: research

Corticosteroids for sore throat.
Abstract In the United States, up to 2% of ambulatory visits are related to sore throats.1 'Sore throat' is a broad term with a wide range of etiologies. Infections are the most common cause, with group A beta-hemolytic streptococcus (GABHS) accounting for 10% of cases in adults and up to 30% in pediatric patients.2,3 A variety of interventions can be used to reduce pain, and while antibiotics are frequently used to treat infection, their overall analgesic effect is likely small and their overuse may lead to bacterial resistance and other adverse events.4,5. PMID: 32989848 [PubMed - as supplied by publisher] ...
Source: Accident and Emergency Nursing - September 27, 2020 Category: Emergency Medicine Authors: Long B, Gottlieb M Tags: Acad Emerg Med Source Type: research

Rapid Administration of Methoxyflurane to Patients in the Emergency Department (RAMPED) Study: A Randomised controlled trial of Methoxyflurane vs Standard care.
CONCLUSION: Initial management with inhaled methoxyflurane in the ED did not achieve the pre-specified substantial reduction in pain, but was associated with clinically significant lower pain scores compared to standard therapy. PMID: 32989888 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 27, 2020 Category: Emergency Medicine Authors: Brichko L, Gaddam R, Roman C, O'Reilly G, Luckhoff C, Jennings P, Smit D, Cameron P, Mitra B Tags: Acad Emerg Med Source Type: research

Faking It.
Abstract It was my second day of clinical rotations. I was checking a sedated patient's breathing, watching her chest move up and down with the whir of the ventilator, when a resident stuck his head in the door. He pointed at me, then pointed down the hall at a group of rapidly retreating backs, and said, "Run." PMID: 32979251 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 25, 2020 Category: Emergency Medicine Authors: Stacy A Tags: Acad Emerg Med Source Type: research

The Use of Electronic Consent for COVID-19 Clinical Trials: Lessons for Emergency Care research During a Pandemic and Beyond.
Abstract The novel SARS-CoV-2 coronavirus poses many unique challenges to the implementation of clinical research, particularly as it relates to the processes of informed consent. Traditional methods of in-person informed consent were no longer plausible, as face-to-face discussions may expose researchers and patients to increased risk of contracting and spreading the virus. In many circumstances the research personnel obtaining consent were considered non-essential workers, and thus did not have priority for personal protective equipment in light of national shortages. PMID: 32970895 [PubMed - as supplied by...
Source: Accident and Emergency Nursing - September 23, 2020 Category: Emergency Medicine Authors: Jaton E, Stang J, Biros M, Staugaitis A, Scherber J, Merkle F, Mohr NM, Streib C, Klein L, Puskarich MA Tags: Acad Emerg Med Source Type: research

Braving it Out.
Abstract Being a 75-year-old emergency physician at the start of a viral pandemic skewed toward older victims is something. But despite pleas from the chair and many others for him to take a leave, the most senior of our faculty by at least a decade continued to work; he even volunteered to do extra shifts if some preferred to stay home. PMID: 32970912 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 23, 2020 Category: Emergency Medicine Authors: Strote J Tags: Acad Emerg Med Source Type: research

SGEM#299: Learning to test for COVID19.
Abstract In late 2019 and early 2020, the COVID-19 virus swept the world, creating a pandemic the likes of which the world hadn't experienced since the influenza pandemic of 1918. Diagnostic signs and symptoms, testing, and treatments were investigated in rapid fashion. In this manuscript, we summarize a scoping review of diagnostic symptoms, signs, and testing along with a discussion with the primary author. PMID: 32965790 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 22, 2020 Category: Emergency Medicine Authors: Heitz C, Morgenstern J, Bond C, Milne WK Tags: Acad Emerg Med Source Type: research

Not Yet Time to Abandon Cervical Collars in Blunt Trauma.
Abstract In the evidence-based summary by Serigano et al. (Ref 1.) published in this issue of Academic Emergency Medicine under the Brass Tacks series, the authors critically appraise the evidence for the long-standing practice of prehospital and emergency department cervical spinal motion restriction (SMR) in blunt trauma patients. They highlight the absence of class I data demonstrating a benefit and describe some of the potentially harmful side effects of cervical collars. PMID: 32966661 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 22, 2020 Category: Emergency Medicine Authors: Baron BJ, Scalea TM Tags: Acad Emerg Med Source Type: research

Re: Prevalence of Pulmonary Embolism in ED patients with Suspected COVID-19: The Truth Remains Unknown.
Abstract We thank « John Doe » et al. for their interest and comments on our paper "Association between Pulmonary Embolism and COVID-19 in ED patients: the PEPCOV international retrospective study". The authors raised the important issue of a possible bias, because we only analyzed patients that were tested for pulmonary embolism (PE) with computed tomography pulmonary angiogram (CTPA). We acknowledge that this is a limitation, and accordingly highlighted in our manuscript that whether these results apply to the general population is unknown. PMID: 32969086 [PubMed - as supplie...
Source: Accident and Emergency Nursing - September 22, 2020 Category: Emergency Medicine Authors: Freund Y, Drogrey M, Cachanado M, Bloom B Tags: Acad Emerg Med Source Type: research

Prevalence of Pulmonary Embolism in ED patients with Suspected COVID-19: The Truth Remains Unknown.
Abstract A strong association between PE and patients hospitalized with COVID-19 (15.3% overall range 0-35%) has been reported, but the prevalence in ED patients remains unknown. The contribution of traditional risk factors is likewise unclear. While Freund et al. attempted to answer to this question, we have methodologic concerns we feel require attention before emergency physicians proceed as if COVID-19 does not increase risk of PE. PMID: 32969120 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 22, 2020 Category: Emergency Medicine Authors: Ehrman RR, Collins J, Harrison N Tags: Acad Emerg Med Source Type: research

Cervical Spine Motion Restriction after Blunt Trauma.
Abstract Spinal immobilization or spinal motion restriction after blunt trauma is a routine practice and standard care in most settings due to fear of movement causing or worsening spinal cord injury. This is ingrained in guidelines for trauma management. Immobilization is typically performed with backboards, cervical collars, sandbags, straps, and vacuum mattresses. The aim of these interventions is to restrict mobility in order to prevent secondary spinal cord injury during extrication and transport. However, the benefits of this approach are unclear while harms are common. PMID: 32959426 [PubMed - as suppl...
Source: Accident and Emergency Nursing - September 20, 2020 Category: Emergency Medicine Authors: Serigano O, Riscinti M Tags: Acad Emerg Med Source Type: research

Sharing is Caring - Can an App Help?
Abstract Parents of febrile young infants who present to the emergency department are frequently overwhelmed, surprised by the potential seriousness of their child's condition and the need for extensive testing and possible hospitalization.1 In this stressful context, communication can be challenging. Emergency physicians are faced with the responsibilities of explaining the need for testing, answering questions, addressing concerns, and providing support. PMID: 32949065 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 18, 2020 Category: Emergency Medicine Authors: Ishimine P Tags: Acad Emerg Med Source Type: research

Child Protection Team Consultation for Injuries Potentially due to Child Abuse in Community Emergency Departments.
Abstract OBJECTIVE: Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In 3 CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children
Source: Accident and Emergency Nursing - September 14, 2020 Category: Emergency Medicine Authors: Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach M, McVaney C, Morrell P, Asnes AG Tags: Acad Emerg Med Source Type: research

The Economics and Effectiveness of Advanced Practice Providers are Decidedly Local Phenomena.
Abstract The growth and promulgation of Advanced Practice Providers (APPs) across the entire spectrum of healthcare delivery has been profound, and APPs are increasingly common members of emergency department (ED) care teams. Emergency APP workforce growth is outpacing that of emergency physicians with little to suggest that this trend will subside. The evolution of the deployment of APPs in emergency care has been dramatic; initially, emergency APPs were deployed to lower acuity patients or environments-minor injury and illness and in conjunction with an emergency physician-hence the now antiquated description of...
Source: Accident and Emergency Nursing - September 13, 2020 Category: Emergency Medicine Authors: Zane RD, Michael SS Tags: Acad Emerg Med Source Type: research

Race and Use of Physical Restraints: Premature conclusions for "Disparities in Care"?
Race and Use of Physical Restraints: Premature conclusions for "Disparities in Care"? Acad Emerg Med. 2020 Sep 11;: Authors: Taylor RA, Boatright D, Wong AH Abstract We read with interest the manuscript by Shnitzer et al.1 on the role of race in physical restraint use and the accompanying invited commentary by Corbin et al.2 We commend the effort put forth in this study as management of agitated patients is a challenging but often overlooked problem. In addition, we agree that racial bias likely exists with regards to physical restraint use, as described in the mental health literature3 and ...
Source: Accident and Emergency Nursing - September 10, 2020 Category: Emergency Medicine Authors: Taylor RA, Boatright D, Wong AH Tags: Acad Emerg Med Source Type: research

Identification of the Physiologically Difficult Airway in the Pediatric Emergency Department.
Abstract BACKGROUND: The risk factors for peri-intubation cardiac arrest in critically ill children are incompletely understood. The study objective was to derive physiologic risk factors for deterioration during tracheal intubation in a pediatric emergency department (PED). METHODS: This was a retrospective cohort study of patients undergoing emergency tracheal intubation in a PED. Using the published literature and expert opinion, a multidisciplinary team developed high-risk criteria for peri-intubation arrest: (1) hypotension, (2) concern for cardiac dysfunction, (3) persistent hypoxemia, (4) severe metabolic acidosis (pH
Source: Accident and Emergency Nursing - September 6, 2020 Category: Emergency Medicine Authors: Dean PN, Hoehn EF, Geis GL, Frey ME, Cabrera-Thurman MK, Kerrey BT, Zhang Y, Stalets EL, Zackoff MW, Maxwell AR, Pham TM, Lautz AJ Tags: Acad Emerg Med Source Type: research

Duel of emergency scoring systems in COVID-19 patient.
Abstract We have read with interest the recent article, "Comparing Rapid Scoring Systems in Mortality Prediction of Critically Ill Patients With Novel Coronavirus Disease" by Hai Hu et al. 1 Although there are many studies about the critical patients hospitalized in the hospital with the diagnosis of COVID-19, we think that this scoring evaluation is very important especially at the bedside since there are no studies evaluating the scores in the emergency department. REMS has come to the fore among the scoring performed to evaluate critical patients in order to recognize the patients at high risk in the ...
Source: Accident and Emergency Nursing - September 6, 2020 Category: Emergency Medicine Authors: Canakci ME, Cetin M Tags: Acad Emerg Med Source Type: research

The comparison of REMS and MEWS for COVID-19 patients under 65 years of age.
Abstract In our previous research, we found that both Modified Early Warning Score(MEWS) and Rapid Emergency Medicine Score(REMS) demonstrated acceptable predictive values for the in-hospital mortality of critical ill patients with novel coronavirus disease (COVID-19) 1 . If each parameter could be collected in a busy emergency department, REMS might be more accurate than MEWS for critical ill patients with COVID-19, especially for the patients aged
Source: Accident and Emergency Nursing - September 6, 2020 Category: Emergency Medicine Authors: Hu H, Yao N, Qiu Y Tags: Acad Emerg Med Source Type: research

The Air We Share.
Abstract The manuscript should be blinded for institution and location as well as authors, as those will often reveal authorship. PMID: 32893400 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 5, 2020 Category: Emergency Medicine Authors: Calello DP Tags: Acad Emerg Med Source Type: research

Randomized Double-Blind Trial of Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department.
The objective of this study was to compare the effectiveness and safety of intramuscular droperidol, ziprasidone, and lorazepam for acute agitation in the emergency department. METHODS: This was a randomized, double-blind trial of ED patients with acute agitation requiring parenteral sedation. The study was conducted under exception from informed consent (21 CFR 50.24) from July 2004 to March 2005. Patients were randomized to receive droperidol 5mg, ziprasidone 10mg, ziprasidone 20mg, or lorazepam 2mg intramuscularly. We recorded Altered Mental Status Scale (AMSS) scores, nasal end-tidal carbon dioxide (ETCO2), and pu...
Source: Accident and Emergency Nursing - September 4, 2020 Category: Emergency Medicine Authors: Martel ML, Driver BE, Miner JR, Biros MH, Cole JB Tags: Acad Emerg Med Source Type: research

Identifying Maltreatment in Infants and Young Children Presenting with Fractures: Does Age Matter?
CONCLUSION: Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: (1) children aged less than 3 years old presenting with rib fractures, and (2) children aged less than 18 months presenting with humeral or femoral fractures. PMID: 32888348 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 4, 2020 Category: Emergency Medicine Authors: Mitchell IC, Norat BJ, Auerbach M, Bressler CJ, Como J, Escobar MA, Flynn-O'Brien KT, Lindberg DM, Nickoles T, Rosado N, Weeks K, Maguire S Tags: Acad Emerg Med Source Type: research

Minimal differences in responses but big differences in rankings: Press Ganey versus PRC.
Abstract Patient satisfaction scores and rankings are reflected in administrative decisions and have been used for 40 years. Survey results can determine physician compensation at the group level and create rankings of individual providers. Externally, satisfaction data is used to rank hospitals against peers and competitors. Rankings can affect longevity of billing contracts and selection of hospital systems by patients and employers1 . Despite importance of patient satisfaction data there is variance as a function of site-dependent factors and small sample sizes. PMID: 32889740 [PubMed - as supplied by publ...
Source: Accident and Emergency Nursing - September 4, 2020 Category: Emergency Medicine Authors: Diercks L, Courtney DM, Piel C, Overstreet S, Mayo M, Diercks D Tags: Acad Emerg Med Source Type: research

Tackling Another COVID-19 Pandemic Disparity - Distance from Major Academic Medical Centers Encumbers Emergency and Critical Care Physician Surge Capacity.
Abstract The COVID-19 pandemic has exposed a number of deficiencies in our US health care system, most notably the disproportionately poor health care outcomes in Latinx and African-American populations.1-3 My experiences over the past two months have shed light on another disparity - the enormous differential in emergency and critical care physician surge capacity between cities with robust medical academic institutions and communities that are situated far away from large medical schools. PMID: 32886821 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 3, 2020 Category: Emergency Medicine Authors: Rodriguez RM Tags: Acad Emerg Med Source Type: research

Systematic analysis of disease-specific immunological signatures in patients with febrile illness from Saudi Arabia.
Conclusions: This study is the first extensive characterisation of the clinical analysis and immune biomarkers of several clinically important febrile infections in Saudi Arabia. Importantly, an immune signature with robust accuracy, specificity and sensitivity in differentiating several febrile infections was identified, providing useful insights into patient disease management in the Arabian Peninsula. PMID: 32864128 [PubMed] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - September 1, 2020 Category: Emergency Medicine Authors: Kam YW, Ahmed MY, Amrun SN, Lee B, Refaie T, Elgizouli K, Fong SW, Renia L, Ng LF Tags: Clin Transl Immunology Source Type: research

Anticoagulation for Distal Lower Extremity Deep Venous Thromboses.
Abstract Deep venous thrombosis (DVT) has an incidence of 45 to 117 per 100,000 person-years.1 Distal DVT, defined as a venous thrombosis isolated to the calf veins, comprises one-third to one-half of all DVTs.2 However, the treatment of distal DVTs is more controversial with significant variations in practice with regard to decisions on anticoagulation.3. PMID: 32860462 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 28, 2020 Category: Emergency Medicine Authors: Gottlieb M, Long B Tags: Acad Emerg Med Source Type: research

Return Hospital Admissions Among 1419 Covid-19 Patients Discharged from Five US Emergency Departments.
Abstract Although many ED patients with known or suspected Covid-19 require hospital admission, the majority are discharged home. Concern for surges in hospital occupancy compel emergency providers to preserve inpatient resources and discern which patients benefit most from admission. Even in the absence of surge conditions, patients may prefer to recover at home if safe to do so. However, some patients with Covid-19 experience delayed decompensation. PMID: 32853423 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 26, 2020 Category: Emergency Medicine Authors: Kilaru AS, Lee K, Snider CK, Meisel ZF, Asch DA, Mitra N, Delgado MK Tags: Acad Emerg Med Source Type: research

July Interns.
Abstract Starting in the midst of a pandemic, we all wore surgical masks and underneath the N95 peaked through, a surgical green. No one recognized us. Our seniors said no one ever recognizes interns. PMID: 32853460 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 26, 2020 Category: Emergency Medicine Authors: Gorgens S Tags: Acad Emerg Med Source Type: research

cotton blossoms.
Abstract mishandled swans litter about bathing in an expectorant lake a broken spine here and there a felled head, an awkwardly bent neck i straighten and repair. PMID: 32854148 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 26, 2020 Category: Emergency Medicine Authors: Manley S Tags: Acad Emerg Med Source Type: research

Indications for Computed Tomography in Older Adult Patients with Minor Head Injury in the Emergency Department.
Abstract BACKGROUNDS: Older age is a risk factor for intracranial injury after head trauma, and computed tomography (CT) is generally recommended. We aimed to develop a clinical prediction rule for risk stratification to avoid CT head imaging in older adult patients with minor head injury, named Computed Tomography of the Head for the patients at Advanced age (CTHEAD). METHODS: This was a single center observational study in Japan that used retrospective chart review data to service a prediction rule that was prospectively validated. Patients aged ≥65 years who presented to our emergency department with a ...
Source: Accident and Emergency Nursing - August 19, 2020 Category: Emergency Medicine Authors: Mori K, Abe T, Matsumoto J, Takahashi K, Takeuchi I Tags: Acad Emerg Med Source Type: research

The Impact of Clinical Seizure Characteristics on Recognition and Treatment of New-Onset Focal Epilepsy in Emergency Departments.
CONCLUSIONS: This study contributes to evidence of under-recognition of non-motor focal seizure semiologies in ED settings, which can support large-scale interventions aimed at improving recognition, specialist consultation, and treatment in ED settings. PMID: 32810323 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 17, 2020 Category: Emergency Medicine Authors: Pellinen J, Tafuro E, Baehr A, Barnard S, Holmes M, French J, Human Epilepsy Project investigators Tags: Acad Emerg Med Source Type: research

Pain score, opioid administration, and delirium: a confounded relationship.
Abstract We read the manuscript, "Relationship Between Pain, Opioid Treatment, and Delirium in Older Emergency Department Patients", by Daoust et al with interest.1 We applaud the effort put forth in this study, as delirium is a commonly encountered problem in hospitalized geriatric patients; however, we have some questions about the study methodology, as well as the interpretation of the manuscript's results. PMID: 32785998 [PubMed - as supplied by publisher] (Source: Accident and Emergency Nursing)
Source: Accident and Emergency Nursing - August 11, 2020 Category: Emergency Medicine Authors: Meaden CW, Ramdin C, Nelson LS Tags: Acad Emerg Med Source Type: research

Pain, and not opioids, is associated with Delirium in older emergency department Patients.
Abstract It is true that the sample size for our cohort was previously calculated by Émond et al.1 to determine the incidence of delirium. However, the logistic regression analysis used in our study included the total 338 patients and not only the 41 patients with delirium. In addition, we reported a power calculation showing that with 338 patients, we had 80% chance of finding an odd-ratio (OR) of at least 1.7 for a predictor of delirium, considering a baseline probability of 0.12 of delirium (41 cases). According to Chen et al.2 an OR of 1.7 is considered a small effect size by Cohen references, so we had...
Source: Accident and Emergency Nursing - August 11, 2020 Category: Emergency Medicine Authors: Daoust R, Paquet J Tags: Acad Emerg Med Source Type: research

When We Keep Going.
Abstract What does it feel like to have acidic blood? In medical school we learned that a pH below 6.8 is generally thought to be incompatible with life. But is it painful? Nauseating? Before my fellowship in palliative care, I completed my residency in emergency medicine. In the ED, diabetic patients presenting with vomiting from ketoacidosis could clock in a pH below 7 and recover quickly. But that was before the hospital ran out of residents to staff the COVID ICU and drafted many of us as fellows to fill in. It was my second to last day covering in the ICU when I saw Mr. L's pH dip below seven. I wondered agai...
Source: Accident and Emergency Nursing - August 11, 2020 Category: Emergency Medicine Authors: Causey A Tags: Acad Emerg Med Source Type: research

Non-steroidal anti-inflammatory drugs for acute low back pain.
Abstract Low back pain is a common reason for emergency department presentation and is a leading cause of acute disability. Up to 70% of individuals experience low back pain during their lifetime. Many patients recover from acute back pain within 6 weeks, but some patients experience multiple episodes or chronic pain.Guidelines recommend avoidance of bedrest, early activity, patient education, attention to patient psychosocial factors, and administration of analgesic medications. Clinical practice guidelines from the American College of Physicians recommend non-steroidal anti-inflammatory drugs (NSAIDs) as a treat...
Source: Accident and Emergency Nursing - August 11, 2020 Category: Emergency Medicine Authors: Long B, Gottlieb M Tags: Acad Emerg Med Source Type: research